Skip to main content

Advertisement

Log in

Bacterial meningitis: Principles and practical aspects of therapy

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Acute bacterial meningitis continues to be associated with significant morbidity and mortality. Recent research efforts to improve outcome for such patients have focused on antibiotic-cerebrospinal fluid interactions, factors influencing antibiotic selection, indications for cranial imaging, the role of anti-inflammatory agents, and the impact of antibiotic timing on outcome. In this article, I use an illustrative case to review timely data on these topics and provide guidelines for the empiric and pathogen-directed treatment of patients with acute bacterial meningitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Durand ML, Calderwood SB, Weber DJ, et al.: Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 1993, 328:21–28.

    Article  PubMed  CAS  Google Scholar 

  2. Aronin SI, Peduzzi P, Quagliarello VJ: Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 1998, 129:862–869. These authors create and validate a prognostic staging system for adults with community-acquired bacterial meningitis. The article shows that disease severity at the time of antibiotic administration is the most important predictor of outcome; the prognostic staging system is used to evaluate the relationship between antibiotic timing and outcome.

    PubMed  CAS  Google Scholar 

  3. Scheld WM, Sande MA: Bactericidal versus bacteriostatic antibiotic therapy of experimental pneumococcal meningitis in rabbits. J Clin Invest 1983 71:411–419.

    PubMed  CAS  Google Scholar 

  4. Zwahlen A, Nydegger UE, Vaudaux P, et al.: Complementmediated opsonic activity in normal and infected human cerebrospinal fluid: early response during bacterial meningitis. J Infect Dis 1982, 145:635–646.

    PubMed  CAS  Google Scholar 

  5. Cherubin CE, Marr JS, Sierra MF, Becker S: Listeria and gram-negative bacillary meningitis in New York City, 1972–1979: frequent causes of meningitis in adults. Am J Med 1981, 71:199–209.

    Article  PubMed  CAS  Google Scholar 

  6. Lepper M, Dowling H: Treatment of pneumococcal meningitis with penicillin compared with penicillin plus aureomycin. Arch Intern Med 1951, 88:489.

    CAS  Google Scholar 

  7. Sande MA: Factors influencing the penetration and activity of antibiotics in experimental meningitis. J Infect 1981, 3(suppl):33–38.

    Article  PubMed  CAS  Google Scholar 

  8. Tauber MG, Doroshow CA, Hackbarth CJ, et al.: Antibacterial activity of b-lactam antibiotics in experimental meningitis due to Streptococcus pneumoniae. J Infect Dis 1984, 149:568–574.

    PubMed  CAS  Google Scholar 

  9. Quagliarello VJ, Long WJ, Scheld WM: Morphological alterations of the blood-brain barrier with experimental meningitis in the rat: temporal sequence and role of encapsulation. J Clin Invest 1986, 77:1084–1095.

    Article  PubMed  CAS  Google Scholar 

  10. Quagliarello VJ, Ma A, Stukenbrok H, Palade GE: Ultrastructural localization of albumin transport across the cerebral microvasculature during experimental meningitis in the rat. J Exp Med 1991, 174:657–672.

    Article  PubMed  CAS  Google Scholar 

  11. Quagliarello VJ, Scheld WM: Drug therapy: treatment of bacterial meningitis. N Engl J Med 1997, 336:708–716. A comprehensive review of the treatment of bacterial meningitis, this article reviews epidemiologic trends of therapeutic importance and principles of antimicrobial therapy for bacterial meningitis. It addresses issues of empirical management of bacterial meningitis, including the timing and selection of antibiotics, and the role of adjunctive corticosteroids.

    Article  PubMed  CAS  Google Scholar 

  12. Hasbun R, Aronin SI, Quagliarello VJ: Treatment of bacterial meningitis. Compr ther 1999, 25:73–81.

    PubMed  CAS  Google Scholar 

  13. Gopal AK, Whitehouse JD, Simel DL, Corey R: Cranial computed tomography before lumbar puncture. Arch Intern Med 1999, 159:2681–2685. This study identifies predictors of new intracranial lesions on CT scan in patients with suspected meningitis. It uses those predictors, in conjunction with the physician’s clinical assessment and the results of a screening questionnaire, to define a subgroup of patients in whom screening CT scanning is likely unnecessary.

    Article  PubMed  CAS  Google Scholar 

  14. Coant PN, Kornberg AE, Duffy LC, et al.: Blood culture results as determinants in the organism identification of bacterial meningitis. Pediatr Emerg Care 1992, 8:200–205.

    Article  PubMed  CAS  Google Scholar 

  15. Blazer S, Berant M, Alon U: Bacterial meningitis: effect of antibiotic treatment on cerebrospinal fluid. Am J Clin Pathol 1983, 80:386–387.

    PubMed  CAS  Google Scholar 

  16. Davis SD, Hill HR, Feigl P, et al.: Partial antibiotic therapy in Haemophilus influenzae meningitis. Its effect on cerebrospinal fluid abnormalities. Am J Dis Child 1975, 129:802–807.

    PubMed  CAS  Google Scholar 

  17. Tunkel AR, Scheld WM: Acute bacterial meningitis. Lancet 1995, 346:1675–80.

    Article  PubMed  CAS  Google Scholar 

  18. Friedland IR, Klugman KP: Failure of chloramphenicol therapy in penicillin-resistant pneumococcal meningitis. Lancet 1992, 339:405–408.

    Article  PubMed  CAS  Google Scholar 

  19. Bradley JS, Connor JD: Ceftriaxone failure in meningitis caused by Streptococcus pneumoniae with reduced susceptibility to b-lactam antibiotics. Pediatr Infect Dis J 1991, 10:871–873.

    Article  PubMed  CAS  Google Scholar 

  20. Viladrich PF, Gudiol F, Linares J, et al.: Evaluation of vancomycin for therapy of adult pneumococcal meningitis. Antimicrob Agents Chemother 1991, 35:2467–2472.

    PubMed  CAS  Google Scholar 

  21. Paris MM, Hickey SM, Uscher MI, et al.: Effect of dexamethasone on therapy of experimental penicillin-and cephalosporin-resistant pneumococcal meningitis. Antimicrob Agents Chemother 1994, 38:1320–4.

    PubMed  CAS  Google Scholar 

  22. Aseni F, Otero MC, Perez-Tamarit D: Risk/benefit in the treatment of children with imipenem-cilastatin for meningitis caused by penicillin-resistant pneumococcus. J Chemother 1991, 5:133–134.

    Google Scholar 

  23. Lopez E: The Meropenem Study Group: meropenem versus cefotaxime or ceftriaxone for bacterial meningitis. In Program and Abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy. 1993. Washington, DC: American Society for Microbiology; 1993:326.

    Google Scholar 

  24. Friedland IR, McCracken GH Jr: Management of infections caused by antibiotic-resistant Streptococcus pneumoniae. N Engl J Med 1994, 331:377–82.

    Article  PubMed  CAS  Google Scholar 

  25. Friedland IR, Paris MM, Ehrett S, et al.: Evaluation of antimicrobial regimens for treatment of experimental penicillin-and cephalosporin-resistant pneumococcal meningitis. Antimicrob Agents Chemother 1993, 37:1630–6.

    PubMed  CAS  Google Scholar 

  26. Quagliarello VJ, Scheld WM: Bacterial meningitis: pathogenesis, pathophysiology and progress. N Engl J Med 1992, 327:864.

    Article  PubMed  CAS  Google Scholar 

  27. Tauber MG, Khayam-Bashi H, Sande MA: Effects of ampicillin and corticosteroids on brain water content, cerebrospinal fluid pressure, and cerebrospinal fluid lactate levels in experimental pneumococcal meningitis. J Infect Dis 1985, 151:528–534.

    PubMed  CAS  Google Scholar 

  28. Syrogiannopoulus GA, Olsen KD, Reisch JS, McCracken GH Jr: Dexamethasone in the treatment of Haemophilus influenzae type B meningitis. J Infect Dis 1987, 155:231–239. [Erratum, J Infect Dis 1987, 155:1359].

    Google Scholar 

  29. Geiman BJ, Smith AL: Dexamethasone and bacterial meningitis: a meta-analysis of randomized controlled trials. West J Med 1992, 157:27–31.

    PubMed  CAS  Google Scholar 

  30. Saez-Llorens X, McCracken GH Jr: Initial management of bacterial meningitis: steroids and antibiotics. Residence Staff Physician 1993, 39:25–29.

    Google Scholar 

  31. McIntyre PB, Berkey CS, King SM, et al.: Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since 1988. JAMA 1997, 278:925–931. This study analyzes 11 randomized, concurrently controlled trials of dexamethasone therapy in childhood bacterial meningitis. It shows dexamethasone to be efficacious in children with Haemophilus influenzae type b meningitis. It also shows the importance of early administration of dexamethasone in relation to antibiotics in children with pneumococcal meningitis.

    Article  PubMed  CAS  Google Scholar 

  32. Girgis NI, Farid Z, Mikhail IA, et al.: Dexamethasone treatment for bacterial meningitis in children and adults. Pediatr Infect Dis J 1989, 8:848–851. While this study is neither placebo-controlled nor double-blinded, it is the only prospective study to date showing dexamethasone’s efficacy for adults with bacterial meningitis. Adults with pneumococcal meningitis treated with antibiotics plus dexamethasone had a significant reduction in both neurological morbidity and mortality, compared with those treated with antibiotics alone.

    Article  PubMed  CAS  Google Scholar 

  33. Saez-Llorens X, McCracken GH Jr: Antimicrobial and antiinflammatory treatment of bacterial meningitis. Infect Dis Clin North Am 1999, 13:619–636.

    Article  PubMed  CAS  Google Scholar 

  34. Radetsky M: Duration of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis. Pediatr Infect Dis J 1992, 11:694–698.

    Article  PubMed  CAS  Google Scholar 

  35. Wenger JD, Hightower AW, Facklam RR, et al.: Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. J Infect Dis 1990, 162:1316–1323.

    PubMed  CAS  Google Scholar 

  36. Van Esso D, Fontanals D, Uriz S, et al.: Neisseria meningitidis strains with decreased susceptibility to penicillin. Pediatr Infect Dis J 1987, 6:438–9.

    Article  PubMed  Google Scholar 

  37. Saez-Nieto JA, Lujan R, Berron S, et al.: Epidemiology and molecular basis of penicillin-resistant Neisseria meningitidis in Spain: a 5-year history (1985-1989). Clin Infect Dis 1992, 14:394–402.

    PubMed  CAS  Google Scholar 

  38. Woods CR, Smith AL, Wasilauskas BL, et al.: Invasive disease caused by Neisseria meningitidis relatively resistant to penicillin in North Carolina. J Infect Dis 1994, 170:453–456.

    PubMed  CAS  Google Scholar 

  39. Dillon JR, Pauze M, Yeung K-H: Spread of penicillinase-producing and transfer plasmids from the gonococcus to Neisseria meningitidis. Lancet 1983, 1:779–781.

    Article  PubMed  CAS  Google Scholar 

  40. Deveikas A, Schauf V, Mizen M, Riff L: Antimicrobial therapy of experimental group B streptococcal infection in mice. Antimicrob Agents Chemother 1977, 11:817–820.

    Google Scholar 

  41. Scheld WM, Fletcher DD, Funk FN, Sande MA: Response to therapy in an experimental rabbit model of meningitis due to Listeria monocytogenes. J Infect Dis 1979, 140:287–94.

    PubMed  CAS  Google Scholar 

  42. Hasbun R, Quagliarello VJ: Use of the quinolones in treatment of bacterial meningitis. In The Quinolones. Edited by Andriole VT. San Diego: Academic Press; 1998:287–301.

    Google Scholar 

  43. Kaufman BA, Tunkel AR, Pryor JC, et al.: Meningitis in the neurosurgical patient. Infect Dis Clin North Am 1990, 4:677–701.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aronin, S.I. Bacterial meningitis: Principles and practical aspects of therapy. Curr Infect Dis Rep 2, 337–344 (2000). https://doi.org/10.1007/s11908-000-0013-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-000-0013-0

Keywords

Navigation